Haiti 2010, Surgery in La Gonave
Just got back from eating supper after a long day in the OR. We finished around 9 pm. Exhausting, but extremely rewarding. Doing anaesthesia without the full range of monitors, with limited drugs, with minimal post anaesthesia care (no oxygen sats, so sides on the beds, hanging IVs from fan strings or sticking to bulletin boards with pins...) is pretty tiring actually! Ravi is also quite tired as he is doing things he isn't used to - an old fourth degree tear worsened by a recent delivery, larger hernias than any of us have seen, children as small as 10 kg, C-sections for twins, looking for bullets in a leg with an entry wound but no exit wound - the list goes on. It is interesting that in spite of this I feel we are providing a very safe surgical experience for these folks who wouldn't otherwise have their surgery done; it just requires a different emphasis and good use of the local nursing who are excellent.
We have between 3 and 6 cases tomorrow, and may have more Monday am before we leave for POP.
Still no time to get photos on this blog - Ravi and I are having trouble getting the images uploaded from his computer, and we've been too busy to sort it out.
We would never work this way at home, but we think the experience will make us much better at what we do. A small bonus compared to the satisfaction of doing cases we know would never be done without someone here...
On a slightly different note, the nurses here are excellent; keen to learn and friendly. The local staff physician (Dr. Ferdinand - also the medical director for the entire island of La Gonave)) has been coming in on many of our cases, and has transformed from being a little reserved to giving a high-five after a good case. The food at the guest house in the Wesleyan compound is amazing, and the missionaries who are here are friendly and obviously very devoted to what they are doing. The local children are beautiful, and the patients are as a rule grateful (and without exception a stoic crew).
Chat soon ... Colm
Saturday, February 20, 2010
Cité Soleil
Haiti 2010, Day 3
Today we transferred to La Gonave; it was with very mixed emotions we left our colleauges at Petit Goave. We had come to do surgery, and we had heard that La Gonave was a conmfortable place to be, so all was well in that regard - but the need at Petit Goave was tremendous and a number of medical people would be leaving with uncertainty about the arrival of replacements.
The drive back to POP (Port au Prince) brought us through a much more devasted place than I recall from the drive out. I don't even remember seeing that kind of poverty and devastation in the poorer areas of India - this point was really driven home when I was told that many of the most shocking sights had been present before the earthquake.
For example, Cite Soleil (though havving an uplifting name), is probably one of the poorest and most dangerous places in the northern hemisphere; until recently the police and military wouldn't even travel there in the evening, and relief organizations required UN escort through the area as kidnappings were as endemic there as malaria. Ironically today the security is better, but the poverty is certainly not. We witnessed hundreds of womwn lining up for food, with long lines controlled by US Marines and UN soldiers from different countries. The shanties looked like they would blow away in the first strong breeze, and don't appear waterproof - this only a few months before the start of hurricane season and there seems to be no plan in place to solve this problem. All over this part of Haiti people who did have homes that would offer a modicum of protection from hurricanes are now living in makeshift shelters or tent cities; even those people whose still standing homes offered a modicum of protection are afraid to sleep inside with the aftershocks.
Today we transferred to La Gonave; it was with very mixed emotions we left our colleauges at Petit Goave. We had come to do surgery, and we had heard that La Gonave was a conmfortable place to be, so all was well in that regard - but the need at Petit Goave was tremendous and a number of medical people would be leaving with uncertainty about the arrival of replacements.
The drive back to POP (Port au Prince) brought us through a much more devasted place than I recall from the drive out. I don't even remember seeing that kind of poverty and devastation in the poorer areas of India - this point was really driven home when I was told that many of the most shocking sights had been present before the earthquake.
For example, Cite Soleil (though havving an uplifting name), is probably one of the poorest and most dangerous places in the northern hemisphere; until recently the police and military wouldn't even travel there in the evening, and relief organizations required UN escort through the area as kidnappings were as endemic there as malaria. Ironically today the security is better, but the poverty is certainly not. We witnessed hundreds of womwn lining up for food, with long lines controlled by US Marines and UN soldiers from different countries. The shanties looked like they would blow away in the first strong breeze, and don't appear waterproof - this only a few months before the start of hurricane season and there seems to be no plan in place to solve this problem. All over this part of Haiti people who did have homes that would offer a modicum of protection from hurricanes are now living in makeshift shelters or tent cities; even those people whose still standing homes offered a modicum of protection are afraid to sleep inside with the aftershocks.
Thursday, February 18, 2010
Over water to La Gonave
Team 2, Day 2 +
Ravi and I have made it off the big island onto the small island. This afternoon we flew in a small single engine 6 seater to La Gonave with Aileen and Raymond. The other option which was originally entertained was to take a converted lobster boat across, but after hearing of the 10 foot swells the boat encountered, we are glad someone chose to fly us over. Thanks to Dan Irvine, I think.
The compound and hospital on La Gonave are really true luxury compared to what we experienced at Petit Goave. It won't be all holiday though - tomorrow we are starting with a large hernia on a 2 year old, and I know after our tour of the hospital tonight that I'll have to be thinking my way through the case and figuring out the equipment at the same time.
Ravi and I have made it off the big island onto the small island. This afternoon we flew in a small single engine 6 seater to La Gonave with Aileen and Raymond. The other option which was originally entertained was to take a converted lobster boat across, but after hearing of the 10 foot swells the boat encountered, we are glad someone chose to fly us over. Thanks to Dan Irvine, I think.
The compound and hospital on La Gonave are really true luxury compared to what we experienced at Petit Goave. It won't be all holiday though - tomorrow we are starting with a large hernia on a 2 year old, and I know after our tour of the hospital tonight that I'll have to be thinking my way through the case and figuring out the equipment at the same time.
Petit Goave - wild and rewarding
Ravi, Aileen and I didn't have much time at Petit Goave, but certainly got a true sense of the kind of wild medical needs there.
This was an outdoor clinic, whose layout changed as the needs and the staffing evolved - 400 patients per day, obstetrics, pediatrics, trauma, infectious disease and a collection of primary care problems were all part of the mix.
Our first day was incredibly intense, with penetrating chest trauma, cerebral malaria in a 12 month old, sepsis in a 1 month old, and an ampuation on an elderly woman who had fractured her arm in the earthquake and only now had come in to be seen. I did one chest tube, one interosseus needle, multiple IVs, and diagnosed my first (but not my last) cases of malaria and typhoid. This was part of my share of the 300 patients seen that day.
My very first patient seen in Haiti was the 14 year old girl with penetrating chest trauma; I had just finished unpacking and a nurse ran over and asked for "any doc to the ICU". Welcome to Petit Goave. The 'ICU' was a stretcher placed under a tree, just out of the drop zone of the coconuts expectantly hanging over us. The girl had been smashed in the head with a rock, then had been stabbed in the chest by a long thin spike. She had sustained not only penetrating chest trauma, but it looked like her liver had been damaged as well and we thought she was bleeding in the abdomen. The decision was made to transfer her, as we really couldn't do a laparotomy here. As the 2 hour transfer would take place in an old pickup truck with no medical supplies driven by someone with no medical training, we would send along Gavin, the surgical resident from Dalhousie. We decided to place a chest tube before transfer, which I managed to do with the basic supplies at hand - this resulted in the pnuemothorax slightly worsening, until we could replace the home-made Heimlich valve with a waterseal unit that Michael managed to dig up from somewhere. Kudos to him as usual.
The team there was incredible. Aside from our group from the maritimes, there was a group of Portland, Oregan firefighters who were awesome - skilled, hard working and very accomodating. There was an internist with extra training in Chinese nedicine, a naturopath, a psychiatric nurse, and a 4th year emergency resident. We really enjoyed working with hthese folks, and we all benefited from each others' skills; Maureen (the naturopathic doc) did her first ever delivery with the teaching of SueLin, the ER resident, and Mike and I got to teach a little about airways, and anaesthetic drugs, and interosseus access.
I'll post a little more about the medicine, and try to get a few photos up as well.
Colm
This was an outdoor clinic, whose layout changed as the needs and the staffing evolved - 400 patients per day, obstetrics, pediatrics, trauma, infectious disease and a collection of primary care problems were all part of the mix.
Our first day was incredibly intense, with penetrating chest trauma, cerebral malaria in a 12 month old, sepsis in a 1 month old, and an ampuation on an elderly woman who had fractured her arm in the earthquake and only now had come in to be seen. I did one chest tube, one interosseus needle, multiple IVs, and diagnosed my first (but not my last) cases of malaria and typhoid. This was part of my share of the 300 patients seen that day.
My very first patient seen in Haiti was the 14 year old girl with penetrating chest trauma; I had just finished unpacking and a nurse ran over and asked for "any doc to the ICU". Welcome to Petit Goave. The 'ICU' was a stretcher placed under a tree, just out of the drop zone of the coconuts expectantly hanging over us. The girl had been smashed in the head with a rock, then had been stabbed in the chest by a long thin spike. She had sustained not only penetrating chest trauma, but it looked like her liver had been damaged as well and we thought she was bleeding in the abdomen. The decision was made to transfer her, as we really couldn't do a laparotomy here. As the 2 hour transfer would take place in an old pickup truck with no medical supplies driven by someone with no medical training, we would send along Gavin, the surgical resident from Dalhousie. We decided to place a chest tube before transfer, which I managed to do with the basic supplies at hand - this resulted in the pnuemothorax slightly worsening, until we could replace the home-made Heimlich valve with a waterseal unit that Michael managed to dig up from somewhere. Kudos to him as usual.
The team there was incredible. Aside from our group from the maritimes, there was a group of Portland, Oregan firefighters who were awesome - skilled, hard working and very accomodating. There was an internist with extra training in Chinese nedicine, a naturopath, a psychiatric nurse, and a 4th year emergency resident. We really enjoyed working with hthese folks, and we all benefited from each others' skills; Maureen (the naturopathic doc) did her first ever delivery with the teaching of SueLin, the ER resident, and Mike and I got to teach a little about airways, and anaesthetic drugs, and interosseus access.
I'll post a little more about the medicine, and try to get a few photos up as well.
Colm
Tuesday, February 16, 2010
In Haiti!
Team 2, Day 1
We are here finally after many starts and stops. Left Montreal at 3 am and got here without much issue. There is an amazing amount of support and relief work going on now - we spent a few hours at the airport and witnessed first hand the volume of support coming into the country. With bittersweet emotions we also saw orphans leaving the country to join their new families.
We are at the guest house house, and deciding how we will distribute our resources (ie people) between La Gonave and Petit Goave.
We have a good team, and the vibes are excellent.
I'll post more when I get a chance.
Colm
We are here finally after many starts and stops. Left Montreal at 3 am and got here without much issue. There is an amazing amount of support and relief work going on now - we spent a few hours at the airport and witnessed first hand the volume of support coming into the country. With bittersweet emotions we also saw orphans leaving the country to join their new families.
We are at the guest house house, and deciding how we will distribute our resources (ie people) between La Gonave and Petit Goave.
We have a good team, and the vibes are excellent.
I'll post more when I get a chance.
Colm
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